PREVENTIVE BENEFITS INCLUDED IN THE MEDICARE ACT OF 2003

The following sections were added as preventive benefits for Medicare beneficiaries:

• §611- coverage of an initial physical exam (it does not cover lab tests) performed within 6 months of a beneficiary enrolling in Part B. If a beneficiary never enrolls in Part B (and many don't because they have other duplicative coverage) they never get this exam. Also, this provision is effective 1/1/05 and is not applied retroactively so only Medicare Part B enrollees after that date will get the exam.

• §612- coverage of cardiovascular screening blood tests covers a cholesterol (lipids and triglycerides) test once every two years at most. It does provide for the addition of other tests within the Secretary's approval but may be limited to only certain individuals and only with the recommendation of the U.S. Preventive Services Task Force. This section is effective 1/1/05.
  
  

• §613 - coverage of diabetes screening tests provides for a fasting plasma glucose test (other tests as the Secretary deems appropriate) and is limited to individuals at high risk for diabetes. This is defined as having any of the following risk factors - htn, dyslipidemia, obesity (BMI>30), previous identified impaired glucose tolerance, OR at least two of the following: overweight (BMI 25 - 30), family history of DM, history of gestational DM or delivery of baby > 9 lbs., age 65 or older. Frequency covered is no more than twice per year. This section is effective 1/1/05.
  
  

• §614 - improved payment for certain mammography services. This excludes payment for mammography services from the fee schedule. For screening mammograms this provision becomes effective upon enactment. For diagnostic mammograms it's effective 1/1/05.

© Copyright, Center for Medicare Advocacy, Inc. 05/05/2008